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Indications

• Diagnostic: effusion/blood/pus/lymph
• Therapeutic: drainage of air/fluid (effusion, blood, pus, lymph)

Sizes

• French gauge (20-32F) = external circumference in millimetres
• 32F used to prevent clot obstruction of tube

Technique

1. Adequately prepared / consented
2. Clinical examination + inspection of CXR: confirm side of insertion
3. Position: (1) supine + arm abducted (2) seated leaning forwards + arms outstretched
   • Skin cleaned w iodine + draped
   • 5th ICS / 3rd ICS (Anterior) anterior to MAL by palpation of ribs
   • LA wheal w 1-2% lignocaine + deep infiltration
4. Insert over rib (avoids neurovascular bundle)
   • 1.5-2cm incision w scalpel (11 blade)
5. Blunt dissection down to pleura using finger + Roberts forceps ? finger sweep to clear adhesions + widen tract
6. Drain guided into intercostal space
   • Aim apically for air / basally for fluid
   • Secure with drain stitch + apply dressing/tape
7. Attach to underwater seal +/- suction
   • Drain bottle below level of patient at all times
   • Minimise resistance: chest tube should be sufficiently wide
   • End of drainage tube should not be > 5cm below level of water otherwise resistance encountered will prevent air from escaping chest tube
8. Check CXR: accurate position + re-expansion
9. Analgesia

Complications

• Laceration/puncture intrathoracic/abdominal organs (prevented by finger sweep)
• Infection
• Damage to intercostal nerve/artery/vein
• Subcutaneous emphysema

Indications for removal

• Full lung expansion
• Drain no longer functioning (air/fluid ceased to drain)
• No longer swinging (can flush drain - remove obstruction with normal saline)

Procedure in removal

X-ray after

1. Off suction
2. With tube clamped

Remove drain in  inspiration